Due to a new law enacted in 2023, Medicare now covers the RSV vaccine for older adults under Part D, which typically covers prescription drugs. This means you shouldn’t incur an out-of-pocket cost.

Respiratory syncytial virus (RSV) is a common virus that causes mild to severe respiratory infections. Its symptoms are similar to those of the common cold, such as a runny nose and cough.

Many people recover quickly, but RSV can lead to more severe respiratory illness in infants, young children, and older adults over age 65. RSV is a leading cause of pneumonia and bronchitis in lower respiratory infections.

Read on to learn more about RSV vaccine coverage under Medicare and its cost.

As of 2023, a new law has made it easier and more affordable for you to get important vaccines under Medicare.

Many vaccines recommended by the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunization Practices are now covered under Medicare Part D, which typically covers prescription drugs.

Who qualifies for the RSV vaccine?

Currently, the CDC recommends adults ages 75 and older receive the adult RSV vaccine, as well as adults over the age of 60 with other conditions that put them at higher risk.

Medicare coverage will apply to qualifying people over age 65 and slightly younger older adults with a qualifying disability or chronic illness.

The out-of-pocket cost of the RSV vaccine will probably depend on the provider, but it tends to range between $300 and $500.

That said, because the RSV vaccine is now covered under Part D, there shouldn’t be an out-of-pocket cost for eligible adults over age 60. Deductibles or copays aren’t going to apply, though you may still have to pay a premium depending on your plan.

Even if you have Medicare Advantage instead of Original Medicare, many Advantage plans include Part D coverage. If they don’t, your coverage may vary. You can explore your coverage options on Medicare.gov.

There are cases when the RSV vaccine might be necessary but Medicare coverage wouldn’t apply because Medicare is a program for people over age 65. For instance, RSV vaccines are also recommended for pregnant people and infants. In this case, private insurance plans may cover the cost if you have one.

There are currently three approved vaccines for adults over age 60:

  • GSK’s Arexvy (protein subunit)
  • Pfizer’s Abrysvo (protein subunit)
  • Moderna’s Mresvia (mRNA)

These vaccines stimulate the immune system to produce antibodies against RSV and have been proven effective in clinical trials. You typically require just one dose.

Some specific vaccines are covered under Part B, which is part of Original Medicare.

For those vaccines covered under Part D, they’re covered if they are deemed to be medically necessary, with the exception of those already covered under Part B.

This means that newly approved vaccines might not be covered immediately. However, your doctor can try to request coverage through the formulary exception process.

For people enrolled in Medicare, Part D now includes coverage for the RSV vaccine. This means you shouldn’t have any out-of-pocket costs and it shouldn’t count toward your deductible. Depending on your Part D plan, you may have a premium cost.

That said, even if you qualify for coverage under Medicare, ask your doctor whether the RSV vaccine is right for you. They may recommend against it if you have a history of allergic reactions to vaccines or other severe allergies.